From staff and wire reports
When a federal judge in Texas struck down the Affordable Care Act on Friday, ruling that its mandate requiring most people to buy health insurance was unconstitutional, it thrust “Obamacare” into the spotlight right at the deadline to sign up for next year’s coverage.
Open enrollment was scheduled to end Saturday in most states, including Texas, and every year, a surge of people sign up at the last minute.
The Centers for Medicare and Medicaid Services sent out an email to millions of Americans on Saturday trying to allay concerns, and HealthCare.gov displayed a red banner alerting people that the court’s decision would not affect open enrollment.
“Are you covered yet?” HealthCare.gov tweeted Saturday. “Hurry!”
Some states have enrollment deadlines in January.
Here is a quick rundown of what happened in Texas and what the ruling means for open enrollment and beyond.
Q: Why did a Texas judge strike down Obamacare?
A: In a lawsuit filed this year, a group of Republican governors and state attorneys general challenged the Affordable Care Act, arguing that the requirement that people have health insurance — known as the individual mandate — is unconstitutional and, therefore, so is the entire law.
At issue was whether the individual mandate compelled people to buy coverage after Congress reduced the tax penalty for people who do not have health insurance to $0. (In 2017, the average tax penalty was $708, according to preliminary data.)
In his ruling, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas said the individual mandate “can no longer be sustained as an exercise of Congress’ tax power.” O’Connor, a George W. Bush appointee, said that he would not “parse the ACA’s provisions one by one,” but that he had to invalidate the whole law.
That does not mean the Affordable Care Act is immediately null. The judge did not issue an injunction to stop federal officials from enforcing the law, and a group of states led by Democrats have promised to appeal the decision.
The case might make its way to the Supreme Court.
Q: Does the ruling change anything for open enrollment?
A: The case could threaten the survival of the landmark health law and, with it, health coverage for millions of Americans, protections for people with pre-existing conditions and much more.
But for now, open enrollment is proceeding as planned.
The case is “still moving through the courts,” the Centers for Medicare and Medicaid Services said in an email Saturday. “The marketplaces are still open for business, and we will continue with open enrollment. There will be no impact to enrollees’ current coverage or their coverage in a 2019 plan.”
But any confusion caused by the Texas court decision could contribute to lower enrollment numbers, which were lagging behind last year’s turnout.
Q: Why are open enrollment numbers down this year?
A: From when open enrollment started on Nov. 1 to Dec. 8, sign-ups in the 39 states that use HealthCare.gov were down about 12 percent compared with the same period last year.
In East Texas, enrollment through at least one health care organization seemed to be reflecting national trends.
Wellness Pointe, a Longview nonprofit agency serving a mostly uninsured and low-income people, saw ACA enrollment drop 59 percent when compared with a year ago, according to a statement from CEO Chad Jones.
Lower enrollment this year might be the result of a few factors. In states with Medicaid expansion, residents might rely less on the federal marketplace for health insurance.
In addition, Congress eliminated the tax penalty for people who go without coverage, lifting pressure off people who only bought coverage under threat of a fine.
Americans might be less aware of the sign-up deadlines. The Trump administration slashed funding for advertising and other forms of marketing by 90 percent last year, and those funds were not restored.
Jones agreed. He cited a shortened enrollment period and cuts to funding, “which meant far less advertising and fewer people doing enrollment.”
He said the state of Texas received $1.25 million in ACA funding for this funding cycle, down from $9.2 million in 2016.
“Additionally, fear over the current ‘public charge’ discussion has resulted in fewer people seeking benefits of any kind,” Jones wrote.
Now, add in the last-minute confusion.
“During a year when most people don’t know when the deadline is, if the only news you hear is that the ACA was struck down, that is only going to hurt enrollment,” said Joshua Peck, a co-founder of the group Get America Covered and the former chief marketing officer for HealthCare.gov during the Obama administration.
Q: Can I still sign up for coverage?
A: For the 39 states that use HealthCare.gov, including Texas, the open enrollment period ended Saturday.
But 11 states and the District of Columbia operate their own marketplaces. The states are California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont and Washington.
The deadlines in those states vary. Some states, such as California, had planned for deadlines that stretch into January. Connecticut, which had planned to end enrollment Saturday, extended its deadline until Jan. 15 in response to the Texas ruling.